Provider Demographics
NPI:1912582164
Name:CASCADE PARK PHARMACY INC
Entity Type:Organization
Organization Name:CASCADE PARK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PH00019615
Authorized Official - Phone:877-425-6337
Mailing Address - Street 1:1412 SW 43RD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4803
Mailing Address - Country:US
Mailing Address - Phone:877-425-6337
Mailing Address - Fax:877-509-6337
Practice Address - Street 1:925 NE 136TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-0995
Practice Address - Country:US
Practice Address - Phone:877-425-6337
Practice Address - Fax:877-509-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy